Innovation in Aging最新文献

Background and objectives: While research on transgender older adults and health is growing, gaps remain about transgender older adults of color, immigrants, and other groups experiencing multiple forms of marginalization who are shaped by concurring experiences of oppression across the life course. This article aims to address these gaps by examining health challenges and supports among transgender older adults-many of whom are racially minoritized and immigrants-through an Equitable Aging in Health framework.

Research design and methods: This community-driven study incorporates qualitative data from 37 transgender older adults from a larger study of 23 focus groups with 208 lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) older adults in California to examine challenges, thriving and surviving strategies, and recommendations regarding health, housing, social services, and caregiving. Data foreground experiences of transgender older adults who are racially underrepresented, immigrants, and have low incomes.

Results: Transgender older adults identified challenges related to healthcare access, housing, employment, economics, and violence that often intersected with disability and aging. Transgender older Latina immigrants experienced elevated challenges related to language barriers, immigration status, and discrimination. Supports included community connections, financial and legal assistance, educational workshops, and homesharing programs. Healthcare access, health experiences, and overall well-being were intricately tied to challenges and supports in housing, social services, healthcare systems, and employment that existed at micro, mezzo, and macro levels.

Discussion and implications: The Equitable Aging in Health framework helps illuminate how challenges and supports described by transgender older adults, including immigrants and older adults who are racially minoritized, can shape health-related experiences for transgender older adults. Policies, services, and programs targeting transgender older adults, thus, would benefit from a multi-level, multi-systems approach.

Background and objectives: Chewing disability may contribute to depressive symptoms in older adults, but causal pathways, accounting for time-varying confounding factors, remain unexplored. Previous research shows an association between chewing disability, loneliness, and depression. This study examines the causal relationship between chewing disability and clinically significant depressive symptoms (CSDS) and whether loneliness mediates this association among older adults.

Research design and methods: In total, 1,277 participants aged ≥60 years, without CSDS at baseline, were selected from a nationally representative study of older adults in Singapore (2009-2015, three waves). Marginal structural models were utilized to estimate total and indirect effects of chewing disability and CSDS over time, where loneliness was treated as a mediator.

Results: Across the study period, 10.3% developed CSDS, 40.7% experienced loneliness, and 33.6% had chewing disability. Individuals with chewing disability had a 48% higher risk of CSDS (RR: 1.48, 95% CI: 1.15-1.82), and the indirect effect through loneliness was 26% (RR: 1.26, 95% CI: 0.99-1.53; 17.3% of the total effect). Nonetheless, the estimates varied by the operationalization of chewing disability and loneliness. A broader definition of chewing disability showed stronger total effects (RR: 1.57, 95% CI: 1.24-1.91), while a stricter loneliness threshold had a greater indirect effect (RR: 1.70, 95% CI: 1.30-2.09; 21.8% of the total effect).

Discussion and implications: Chewing disability increases the risk of CSDS among older adults, with partial mediation by loneliness. Further research on oral rehabilitative interventions that improve chewing function and mitigate depressive symptoms in older adults is needed.

Background and objectives: Perceived stress is associated with poor health outcomes, including accelerated cognitive decline and increased risk for dementia. Prior research suggests that emotion regulation may determine the extent to which stress impairs cognition with age. This study extends this work by examining the moderating role of two emotion regulation strategies (cognitive reappraisal; expressive suppression) on the relationship between perceived stress and cognitive decline over 10 years in a sample of older adults.

Research design and methods: The sample was drawn from the Midlife in the United States Study (MIDUS; N = 468; Mean age at baseline = 60.24), providing measures of perceived stress, emotion regulation, and cognition at baseline and follow-up (episodic memory; executive functioning). Moderation analyses with 5,000 bootstrapped samples were conducted in the PROCESS Macro and statistically adjusted for age, sex, education, household income, medications, and baseline cognition.

Results: Results revealed that perceived stress interacted with expressive suppression to predict later episodic memory performance. As stress levels increased, only individuals endorsing regular use of expressive suppression exhibited significant memory decline. By contrast, cognitive reappraisal did not significantly moderate relationships between stress and later cognition.

Discussion and implications: Findings highlight that habitual suppression of emotional expression may amplify the consequences of perceived stress on memory decline in late life. Promotion of adaptive emotion regulation may play a role in mitigating the effects of stress on cognitive outcomes among older adults.

Background and objectives: The evidence-based Adult Day Services (ADS) Plus program, delivered by ADS staff to caregivers, offers dementia education, support, and strategies to manage care challenges and has been shown in randomized trials to decrease caregiver depressive symptoms and increase ADS utilization. This study examines costs, cost savings, and caregiver willingness to pay (WTP) and ability to pay (ATP) for this evidence-based program.

Research design and methods: In a 34-site cluster-randomized trial (16 ADS Plus sites; 18 ADS-only usual care sites) involving 203 caregivers, we surveyed program delivery costs, payer-perspective costs (healthcare utilization, formal care/social services utilization), and societal-perspective costs (caregiver time + payer costs) at baseline and 12-months. Enrollees were caregivers who reported on their outcomes and those of the person living with dementia. Costs were calculated using unit costs or appropriate wage rates. We assessed mean per-dyad costs and the between-group difference in mean change in payer and societal costs from baseline to 12-months. Multilevel mixed models considered clustering, and caregivers' WTP and ATP were evaluated.

Results: ADS Plus delivery costs were $433/dyad over 12-months. From the payer perspective, ADS Plus resulted in nonstatistically significant but policy-significant cost savings of $1,501 (95% CI: -$2,771 to $4,804). From a societal perspective, ADS Plus led to cost savings of $1,185 (95% CI: -$11,187 to $7,036). ADS Plus caregivers' median per-session WTP was $90 at baseline and $100 at 12-months, compared to $50 and $100 for usual care. ADS Plus caregivers' median ATP was $31.50 at baseline and $50 at 12-months, versus $25 at both timepoints for usual care.

Discussion and implications: Adult Day Services Plus yielded meaningful cost savings, though statistical significance was not achieved. Caregivers were WTP and ATP toward ADS Plus sessions, which could offset program costs. This study elucidates the financial implications of incorporating caregiver support into community-based dementia care programs.

Background and objectives: Despite the rapid growth of older Asian American populations, little is known about their retention and its associated factors in longitudinal aging studies, partially due to the limited longitudinal studies among this population. This study addresses this critical gap by examining key predictors of attrition in this understudied population.

Research design and methods: Using data from the Population Study of Chinese Elderly in Chicago (PINE), a large longitudinal epidemiological study of older Chinese immigrants in the United States (US), we analyzed the effect of sociodemographic, immigration, health, and psychosocial characteristics on attrition status and various attrition patterns.

Results: High levels of acculturation and longer length of stay in the US were associated with a higher likelihood of attrition. Also, participants with higher levels of educational attainment and loneliness were more likely to drop out of the study earlier. In addition, participants with lower income were more likely to remain in the study.

Discussion and implications: These results show unique attrition dynamics in older Asian immigrants, where acculturation and education paradoxically increase attrition risk. These findings highlight the need for tailored retention strategies to enhance continued participation in longitudinal aging studies among older Asian American immigrants.

Background and objectives: Population aging affects health and social care needs. Although its effects on healthcare needs have been widely discussed, less has been said about its implications on social care needs, even though the consequences of living with chronic conditions are related to functional decline, disability, dependency, and mobility limitation. This study aims to identify trajectories of healthcare and social care needs after the onset of chronic conditions, as well as to explore through cross-country comparisons how demographic, socioeconomic, living arrangements, and health-related dimensions explain individuals' trajectories.

Research design and methods: Using data from the Survey of Health, Ageing and Retirement in Europe, we analyzed trajectories of 16,718 individuals aged 50 and above from 10 European countries through sequence analysis. Multinomial regression models were fitted to understand the factors that explained these trajectories.

Results: This study identified four trajectories after the onset of chronic conditions: (a) "Persistent multimorbidity and social care needs," (b) "Persistent multimorbidity without social care needs," (c) "One chronic condition and social care needs," and (d) "One chronic condition without social care needs and some recoveries." The models present divergences in individuals' characteristics, including demographic and socioeconomic aspects, as well as differences by country, related to each trajectory.

Discussion and implications: By acknowledging trajectories within health and social care needs, we showed the challenges posed by aging processes, which require tailored-made and person-centered services oriented towards preventing and postponing the onset of chronic conditions as well as dealing with their consequences on individuals' daily lives.

Background and objectives: In recognition of the aging population and aged care workforce shortages, calls have been made for responsive and effective strategies for this workforce group. This study aimed to investigate the feasibility, acceptability, and preliminary efficacy of an online mentoring program for aged care support workers serving older adults in New Zealand residential care facilities.

Research design and methods: This mixed-methods study consisted of (1) a nonrandomized single-arm intervention study, with outcome measurement at baseline, 3- and 6-month (Satisfaction with Life Scale, Generic Job Satisfaction, Perceived Stress Scale, and General Self-Efficacy Scale) and (2) a post-intervention qualitative descriptive study exploring perceived acceptability and feasibility aspects of the proposed intervention. Participants met once a month, for 30-60 min. They followed a program manual to work on self-identified goals.

Results: Thirty-eight support workers enrolled, and 22 of them took part and completed the 6-month program. The recruitment target was reached within the proposed 3-month timeframe. Data collection procedures were considered practical and convenient. Participants (13 mentees and 9 mentors) reported that the program was appealing and relevant, its duration and intensity appropriate, and the online delivery acceptable. Participants proposed refinements to improve their experience further. Exploratory outcomes analysis found all measures trended in the expected direction.

Discussion and implications: The WeCare Mentoring Program was found to be a feasible and acceptable intervention. Participants reported several improvements in their well-being and their caregiving-related skills. The next step is to test the intervention's effectiveness in a definitive controlled trial or quasi-experimental study. If future efficacy trials prove successful, this program can offer a much-needed support to the aged care workforce, and lead to better outcomes for them and the people they care for.

Background and objectives: Social engagement is widely recognized as a protective factor for mental health in later life, yet most studies treat it as a static condition and overlook potential asymmetries in the effects of becoming socially engaged and disengaged. This study examines (1) whether the mental health effects of entering and exiting social engagement are asymmetric, (2) whether these effects differ by the type of engagement (informal vs formal), and (3) whether gender moderates these associations.

Research design and methods: Using 7 waves of data from the Korean Longitudinal Study of Aging, we analyzed 6,762 older adults aged 65 and older. Asymmetric fixed effects models were employed to estimate within-person changes in depressive symptoms associated with entry into and exit from social engagement. Gender-stratified models and interaction terms were used to examine differential effects by gender.

Results: Transitions into and out of social engagement were significantly associated with changes in depressive symptoms, but no statistically significant asymmetries were found for either informal or formal engagement in the full sample. However, gender-stratified analyses revealed asymmetric effects for formal social engagement: women benefited more from entering engagement, whereas men were more negatively affected by exiting it. No gender differences or asymmetries were observed for informal social engagement.

Discussion and implications: These findings underscore the importance of distinguishing between types of social engagement and considering gender differences when designing interventions. Policies that support both prevention and re-engagement-particularly those that are gender-sensitive and address formal social roles-may be most effective in promoting mental health among older adults.

Background and objectives: Frailty is a dynamic syndrome increasing older adults' vulnerability to adverse outcomes. Longitudinal data on frailty transitions and their influencing factors remain limited. We aimed to examine bidirectional frailty transitions among middle-aged and older adults using a multi-state Markov (MSM) model.

Research design and methods: Data were obtained from four waves (2011-2018) of the China Health and Retirement Longitudinal Study (CHARLS), including 15 763 participants aged ≥45 years. Frailty was assessed using a 32-item frailty index. MSM models estimated transition probabilities, mean sojourn times, and covariate effects. Additional analyses examined age- and gender-specific patterns and included an age × gender interaction term.

Results: Baseline prevalence of robust, pre-frail, and frail states was 44.3%, 39.4%, and 16.3%, respectively. Within one year, pre-frail participants had probabilities of 18.0% reverting to robust and 19.7% progressing to frail states. At five years, these probabilities were 23.4% and 33.4%, respectively, with mortality increasing to 19.7%. Older age increased frailty progression and mortality risks but reduced recovery likelihood. Notably, significant age × gender interactions were observed for transitions from pre-frail to robust and from frail to death. Men showed higher recovery rates but greater frailty-related mortality than women. Urban residency, higher education, and marriage were protective, while smoking and alcohol increased frailty risk.

Discussion and implications: Frailty among middle-aged and older Chinese adults demonstrates substantial bidirectional transitions, indicating notable opportunities for intervention and prevention. Age, gender, socioeconomic status, and lifestyle behaviors are key modifiable determinants influencing frailty progression and recovery. Public health strategies prioritizing targeted screening and preventive interventions-particularly among vulnerable groups-could effectively mitigate frailty progression, promote recovery, and improve overall population health outcomes.

Background and objectives: The growth in older adults living with disabilities and the decline in the workforce call for technology-driven nursing services to alleviate the burden. Functional assistive robots have emerged as a promising solution; however, their acceptance and attitude toward them remain underexplored. Therefore, this study aimed to investigate the attitudes and requirements of older adults living with disabilities regarding functional assistive robots.

Research design and methods: A mixed-methods study was conducted between November 2023 and January 2024, comprising a cross-sectional survey of 85 older adults with varying levels of disability and semi-structured interviews with 10 participants. Quantitative data were analyzed descriptively, and qualitative data were thematically analyzed to enrich and contextualize the findings.

Results: Fifty-three percent of participants expressed willingness to use a functional assistive robot, with safety, affordability, ease of use, and multifunctionality identified as the most influential factors. Walking assistance and toilet transfer were the most desired functions across all disability levels. Qualitative findings reinforced the quantitative findings, revealing dissatisfaction with current aids due to their limited stability and maneuverability, alongside a strong desire for increased independence and reduced strain on family caregivers. Attitudes toward robots ranged from enthusiasm to skepticism, influenced by perceived usefulness, disability level, and care context. Participants emphasized the need for compact, stable designs with simple interfaces, and some expressed interest in light social features, provided they did not compromise core functionality.

Discussion and implications: This study highlights the demand for functional assistive robots that address critical mobility-related tasks. Functional assistive robots are viewed as promising, but adoption hinges on improving safety, usability, and affordability. Multifunctional, user-friendly designs are essential for practical use. The findings offer guidance for nurses, caregivers, and developers by clarifying core functional needs and concerns, supporting the creation of acceptable technologies that enhance autonomy and quality of life.